California’s editorial pages on Gov. Brown and Medi-Cal expansion

As we debate the question of how California goes about its Medi-Cal expansion, many of the major editorial boards of the state have weighed in. Here’s some of the key insights and excerpts from leading California newspapers:

The LA Times: Put Medi-Cal on the front burner

California legislators are now debating competing visions for how to do that in Medi-Cal, the state’s Medicaid program: an expansive approach promoted by Assembly Speaker John A. Perez and Sen. Ed Hernandez (D-West Covina), and a far more cautious one advanced by the Brown administration. The governor has some valid concerns, but the bills by Perez and Hernandez are less likely to leave vulnerable Californians uninsured…

Diana S. Dooley, California’s secretary of Health and Human Services, says the administration needs to understand the effects of the changes wrought by the law, so it wants to modify the current system only where it has to. That’s one explanation for the amendments the administration has sought in the Medi-Cal simplification bills advanced by Perez and Hernandez, which would streamline entry into Medi-Cal and standardize its benefits. A less charitable explanation is that the administration is trying to cut costs by minimizing the number of Medi-Cal beneficiaries, leaving other low-income Californians to seek subsidized coverage through a new state insurance exchange. Although the exchange will make it simpler to shop for insurance, the out-of-pocket costs will still render coverage unaffordable for many. The administration also opposes the bills’ efforts to replace all enrollment paperwork with electronic verification, which it argues would go further than federal law allows.

The increased cost of Medi-Cal and the risk of fraud are legitimate concerns. But the point of this exercise is to open the doors to Medi-Cal wider so that more poor Californians can be covered. After all, the public pays for their care regardless — typically in the form of higher medical bills and insurance premiums. And for the next three years, the federal government will cover nearly the entire cost of the newly eligible Medi-Cal recipients. The state should maximize participation now, when so many federal dollars are available, then scale back later if necessary.

The state is expected to expand Medi-Cal eligibility to childless adults and more families near the poverty line, as allowed by the 2010 law. But even so, it will barely make a dent in the number of eligible Californians who sign up for coverage, recent projections show — in part because of the difficulties faced by those who don’t speak English. In other words, the lack of coverage among the very poor is deeply entrenched. The Brown administration should join lawmakers in attacking the problem as aggressively as it can.

The Mercury News: John Perez’s bill is the best path to health care reform in California

California will decide in the next 10 days if it really wants to be the national leader in health care reform. It has a golden opportunity to improve its health care system by so much for so little state money.

The Legislature will begin the debate Tuesday on two crucial bills to expand Medi-Cal eligibility to as many as 1.4 million low-income residents. Assembly Speaker John Perez’s AB1X-1 is the best plan. It would insure as many people as possible in the cheapest, most efficient manner.

President Barack Obama’s health care reforms would pay the entire cost of the Medi-Cal expansion for the next three years. Beyond that, California’s costs would be capped at 10 percent. It’s an incredible bargain. After three years of not paying a dime beyond setup and some administrative costs, California would receive $9 from the federal government for every $1 it invests, when the typical split on health care is 50-50. The state could gain as much as $9 billion and dramatically reduce the number of people ending up in emergency rooms for lack of routine care.

Gov. Jerry Brown is dubious. He says the plan will cost billions, but health care experts estimate around $100 million. It’s a huge gap that credible analysts have to resolve. But assuming the analysis comes out closer to the low end, this is something California has to do…

Federal reforms offer California the chance to largely solve its health care problems. Given the huge burden the current system places on the state and counties, it makes sense to capture all the federal money available and insure as many people as possible. Brown’s caution, usually right on target, may be missing the big picture in this case.

The Sacramento Bee:  State must ease sign-up for health coverage

The Affordable Care Act, also known as Obamacare, requires individuals to have health insurance starting in January 2014. Yet with just eight months to go before an October online launch to get people signed up, much remains to be done to revamp an enrollment system that is antiquated and heavy on paperwork…

The process of accessing coverage should be as easy and burden-free as possible.

The old days of searching for paper pay stubs, bank statements, utility bills and other documents should be greatly reduced in this high-tech era, where states can check address, citizenship, employer and income information electronically and get people covered quickly – without in-person lines, crowds or 45-day delays…

Early on, Gov. Jerry Brown had proposed amendments that would have the state stick with the current outdated paper verification system. But Health and Human Services Secretary Diana Dooley told The Bee editorial board on Thursday that has changed with new federal guidance released Feb. 21. Dooley said California is committed to checking residency and income electronically as a first choice, and where that doesn’t work, using the old paper system as a backup.

This needs to get settled quickly. Information technology experts need to know now how the governor and legislators want verification to work so they can program it in time for the October enrollment launch….
 As we move to a culture of coverage – where individuals have to carry health insurance – we need to eliminate excessive bureaucracy and unnecessary complexity. It is time to move California’s enrollment system into the 21st century.

If people are required to be covered, as they are under the Affordable Care Act, the process for getting coverage should be easy to understand and navigate, saving the state administrative costs, too.
 The governor and Legislature need to get a sense of urgency about this, as the enrollment launch is a short eight months away.

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